Guest Post:I am thrilled and honored to have a guest post today from Barbara O’Brien. Barbara’s blogging at The Mahablog, Crooks and Liars, AlterNet, and elsewhere on the progressive political and health blogophere has earned her the notoriety of being a panelist at the Yearly Kos Convention and a featured guest blogger at the Take Back America Conference in Washington, DC. I read The Mahablog daily, and am always interested in the thoughtful and provocative posts there, so we are very excited here at Deep Sand to have our very first guest post, and we couldn’t be more excited that it’s Barbara.

Many obstacles and stumbling blocks remain in the way of health care reform. The House and Senate bills will have to be merged, and then the House and Senate both will vote on the final bill. We don’t yet know what will be in the final bill, or if the final bill will be passed into law. Passage will be especially difficult in the Senate, where it will need 60 votes to pass. It is still possible that after all this angst, just one grandstanding senator could kill the whole thing.

But just for fun, let’s look at what conventional wisdom says will be in the final bill and see if there is anything in it that will be an immediate benefit to people with mesothelioma cancer and other asbestos-related disease.

It is likely that the final bill will provide additional funding for state high-risk insurance pools. Currently more than 30 states run such pools, which are nonprofit, state-sponsored health insurance plans for people who can’t buy insurance because of pre-existing conditions. The biggest problem with such pools is that, often, the insurance they offer is too expensive for many who might need it. Both the Senate and House bills provide $5 billion in subsidies for state high-risk pools to make the insurance more affordable.

Under the Senate bill, beginning in 2014, private companies would no longer be able to deny coverage to adults with pre-existing conditions, nor could they charge higher premiums for people with pre-existing conditions. Until then, the state high-risk pools could provide some help.

Closing the Medicare Part D coverage gap — also called the “doughnut hole” — is another potential provision that could help some patients with asbestos-related disease. The “doughnut hole” is the gap between the coverage for yearly out-of-pocket expenses provided by Medicare Part D and Medicare’s “catastrophic coverage” threshold.

For example, in 2009 Medicare Part D paid at least 75 percent of what patients paid for prescription drugs up to $2,700. After that, patients must pay for all of their prescription medications until what they have paid exceeds $6,154. At that point, the catastrophic coverage takes over, and Medicare pays for all but 5 percent of the patient’s drug bills. The final health care reform bill probably will provide for paying at least 50 percent of out-of-pocket costs in the doughnut hole.

You may have heard the bills include budget cuts to the Medicare program, and this has been a big concern to many people. Proponents of the bill insist that savings can be found to pay for the cuts, and that people who depend on Medicare won’t face reduced services. But this is a complex issue that I want to address in a later post.

The long-term provisions probably will include many other provisions that would benefit patients with asbestos-related disease, including increased funding for medical research. Although there are many complaints about the bill coming from all parts of the political spectrum, on the whole it would be a huge benefit to many people.

Below is a youtube of a segment from Meet The Press this past Sunday in which E. J. Dionne calls out Sen. Orrin Hatch for the Republican’s continuing bullshit about the use of reconciliation to pass things based on a simple majority vote in the Senate. We need to be discussing policy and health insurance reform (or elimination), but instead, all the Republicans can come up with to try to “win” is to run around like Chicken Little complaining that the sky will fall if some Senate procedure is “out-procedured.”

[callout title=Misdirection on the Polls.]At one point during the interview Hatch claims the polls show that 58% of Americans don’t like the reform bill, “and only a few like it.” Well, sounds me to as if 42% must like it…that’s not just “a few.” In addition, while there is one poll with that result, others show a majority favoring reform, and when the provisions of the Bill are explained to people, they actually like the provisions in the bill. Funny how that works.[/callout]The host puts up portions of a Hatch statement in which he says things like:

“would be unprecedented in scope,” –BS meter high-turns out the Republicans used reconciliation to pass the Bush the tax cuts which added $1.7 trillion to our federal deficit. I realize in Congress they don’t have much of a concept of money, but $1.7 trillion to me is pretty unprecedented in scope.

“the havoc wrought would threaten our system of checks and balances” –BS meter through the roof-the system of checks and balances is based on three equal branches of government, each have a check on the other two. What procedures Congress decides to use in how it how it acts on legislation has nothing to do with “checks and balances.”

“corrode the legislative system” – BS meter headed to low earth orbit-lest we all forget (which the Republicans are counting on) there is NOTHING, nada, zilch, zero, in the Constitution about the Senate requiring a sixty vote majority to pass normal legislation. The Constitution does require certain super-majorities in very special situations, but not for passing every-day legislation. This magical sixty vote thing is purely a creation of the Senate, and for those who argue about majority rule, this “super-majority” requirement would seem to fly in the face of that.

“degrade our system of government” –BS meter now on an inter-planetary trajectory-A sitting member of the most corrupt Senate (and government in general) has the temerity to talk about “degrading our system of government?” This is the system has not created a system of state sponsored torture, taken us into a war of aggression against a country that had done nothing to us, has shredded the Constitution with the so called PATRIOT Act. Senator, “have you no shame?”

[youtube:http://www.youtube.com/watch?v=0bjFKvhxzjg]

I just can’t fathom how these people can sit there and lie with a totally straight face. I am convinced they could not and would not tell the truth if that actually favored them.

And I continue to ask the question, how is it people believe that private companies provide better health care insurance. Below is the story of a lady who fell and broke her wrist. She’d been covered by the same insurance company for years. They first denied the claim…and the reason given by the insurance company…because it’s not covered because it was a pre-existing condition.

Not too surprisingly, the story is about the suspicion of many that insurance companies simply deny claims, and are slow to respond to challenges knowing some people won’t challenge the denials, and others will give up. There is NO suspicion in my mind about this. I have the records to prove it.

On every single dental claim I’ve ever filed, the insurance company has initially denied the single most expensive item on the bill. When challenged, they always pay the item, so it’s clear they know they are supposed to pay them, they just hope, as a matter of policy, that if they deny claims, some percentage of people won’t challenge them. That was the case with the lady in story. When challenged, they paid. I don’t believe for a minute they did it just to make her go away, they knew they were contractually obligated to pay it as a covered expense. I wonder why no lawyer has ever sought a class-action lawsuit against insurance companies for breech of contract?

In some cases, the reason for their denial has been that the dentist used the wrong Code for the procedure. Funny thing about that though, when I asked them what would be the correct code, they always answer with, “Well we don’t know that, it’s just that this one is the wrong one.” I finally explained that I watched my dentist run his finger down the list of the ADA codes, so I had to assume they had a different list of codes. At first, they told me they didn’t have different codes, and only used the ADA codes. So I asked them to send me a copy of their codes…to which they responded that they couldn’t because, “that would be giving out confidential company information.”

So let’s be sure I summarize this for the proponents of private insurers. They claim they use standard published ADA codes which I can get from the American Dental Association, but they can’t provide their version of that list because it is confidential corporate information. The Ombudsman for the Virginia Insurance Department says otherwise, and I finally got the list. Once I did, amazingly, they no longer used that as a reason for denying claims.

So what was the next excuse. Well it was a whopper. After having some emergency dental work done in Boston while on a business trip, they denied the claim because the name and address of the provider wasn’t on the claim form. It should be noted, I called them to be sure I was using the correct and current claim form (as they had been purchased by United Healthcare), but there was no place on their claim form that asked for the provider information. I pointed this out, but pointed out that it was on the bill from the Dentist, and they obviously had it, as it was printed on the explanation of benefits (EOB) they had sent.

Denial Code #2, the lady wasn’t sure what it meant, and said that sometimes, if they didn’t have an exact code, they would use just any code…so help me God, that was what she said. She couldn’t explain how we’d ever resolve the situation if the insurance company itself wasn’t sure of the reason for the denial.

Denial Code #3, they were insisting that the I provide them a copy of the Dentist’s license. The Dentist laughed at that, explained he got checks daily from United Health care, and had never provided a “copy” of his license. I checked with two other dentists, and they’d never been asked for such a thing either. In fact, the dentist I go to here in Tampa is not in their network or any other network, and I’ve never been asked to provide his license, but of course I was going to him back when they were still using the “wrong code” dodge.

I explained to the lady that it was silly, since even if his license was revoked or suspended, no State sent out “license police” to collect the licenses, and asked her if she’d ever heard of Photoshop, and explained I could probably create a license for the guy in about 10 minutes. I told her to look on-line for Massachusetts, and find their public listing of licensed professionals. She said they had a team of people that did just that. I never pressed the issue about why, if that were the case, why were they asking me for the information. She called back two days later to tell me that their people couldn’t find such a website or listing for the Commonwealth of Massachusetts, so while I had her on the line, I found it. They refused to reimburse me for my time doing their research.

So this story comes as no surprise, but people continue to believe that somehow private companies have your best interests at heart when it comes to taking care of your health. Please…get real.

And now, finally, some on the conservative right come forward, and tell us the real reasons we can’t have government run insurance (not health care, but insurance to pay for health care). First David Brooks writes in an op-ed in the New York Times opposing a public health insurance option. Brooks’ opposition is based on the fact that it wouldn’t bring to the problem any efficiencies (because, you know, private health insurance companies make the healthcare system so efficient), but his article admits:

The authors of these bills have tried to foster efficiencies. The Senate bill would initiate several interesting experiments designed to make the system more effective — giving doctors incentives to collaborate, rewarding hospitals that provide quality care at lower cost. It’s possible that some of these experiments will bloom into potent systemic reforms.

But the real reason, as it comes out in a later paragraph is, “Reform would make us a more decent society…,” and of course we can’t have that.

Havard economics professor Greg Mankiw agrees with Brooks, and offers this explanation as to why we can’t have any reform of the current healthcare insurance system:

Put simply, the health care reform bill would make the United States more like western Europe. That may mean more security about health care, but it also means that future generations of Americans will likely spend more time enjoying leisure.

So let me sum up the position of this Harvard (are your serious?) Professor. In order to get more security about healthcare, the trade-off will mean that our children get to enjoy more leisure time. Please don’t throw me into that briar patch.

Now those are definitely some good reasons to get behind for opposing health care insurance reform…ghess. Really, who could possibly want average Americans to enjoy more leisure time, and we sure as hell can’t go around building a more decent society. What was I thinking!

As usual, Keith Olbermann does a good job of explaining the need for healthcare reform, and explaining the public option. Olbermann cites a comment by Winston Churchill:

Churchill’s argument was this, “I have heard it said that the government had no mandate such a doctrine is wholly inadmissible. The responsibility for the public safety is absolute and requires no mandate!”

And there is the essence of what this is. What, on the eternal list of priorities, precedes health? What more obvious role could government have than the defense of the life, of each citizen? We cannot stop every germ that seeks to harm us any more than we can stop every person who seeks to harm us. But we can try dammit and government’s essential role in that effort facilitate it, reduce its cost, broaden its availability, improve my health and yours, seems, ultimately, self-explanatory.

So Rep. Scott Plakon and Sen. Carey Baker have introduce a Constitution Amendment that says:

To preserve the freedom of all residents of the state to provide for their own health care:

A law or rule shall not compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system.I called the offices of both.

How very Orwellian of them, protecting your freedom by removing your options. Who is more free than the man who has no obligation to choose?

Tom in Baker’s office tells me that this has no teeth…it’s just designed to send a message to Washington. You know, because the State of Florida has unlimited resources for operating the legislature and conducting elections on things that “have no teeth.”

Now Brandon Delanois in Rep. Plakon’s office was the most entertaining. First, he explained that he was, prior to going to work for the Representative, paying for his own health insurance, and had a plan for only $15.00 per month, but of course, refused to tell me what company was providing plans for only $15.00 per month.

I asked, “so the people who don’t have health insurance…who pays for them when they get sick?” His answer was, “Anyone can go to an emergency room and get care. They won’t turn away anyone.” Of course I pressed him on who he thought paid for that “free” care at the ER. He finally agreed it was taxpayers.

But his argument was that the government should not mandate how people behave, and what choices they make. That the government should not require people to purchase insurance. So I asked him if the Representative would introduce a bill to rescind the law requiring that Florida residents who drive have auto insurance. Well, as you might imagine. according to him, that’s not the same thing.

The jest of what I got out of this is that these two dweebs are merely playing for votes and publicity. I think we should give it to them, and not stop talking about how much it costs the taxpayers to pay for uninsured people, and just how much it costs the taxpayers for each bill that introduced, and what it costs to have a Constitutional Amendment on the ballot. You know, since Florida has so much surplus money floating around.

So Rep. Scott Plakon and Sen. Carey Baker have introduce a Constitution Amendment that says:

To preserve the freedom of all residents of the state to provide for their own health care:

A law or rule shall not compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system.I called the offices of both.

How very Orwellian of them, protecting your freedom by removing your options. Who is more free than the man who has no obligation to choose?

Tom in Baker’s office tells me that this has no teeth…it’s just designed to send a message to Washington. You know, because the State of Florida has unlimited resources for operating the legislature and conducting elections on things that “have no teeth.”

Now Brandon Delanois in Rep. Plakon’s office was the most entertaining. First, he explained that he was, prior to going to work for the Representative, paying for his own health insurance, and had a plan for only $15.00 per month, but of course, refused to tell me what company was providing plans for only $15.00 per month.

I asked, “so the people who don’t have health insurance…who pays for them when they get sick?” His answer was, “Anyone can go to an emergency room and get care. They won’t turn away anyone.” Of course I pressed him on who he thought paid for that “free” care at the ER. He finally agreed it was taxpayers.

But his argument was that the government should not mandate how people behave, and what choices they make. That the government should not require people to purchase insurance. So I asked him if the Representative would introduce a bill to rescind the law requiring that Florida residents who drive have auto insurance. Well, as you might imagine. according to him, that’s not the same thing.

The jest of what I got out of this is that these two dweebs are merely playing for votes and publicity. I think we should give it to them, and not stop talking about how much it costs the taxpayers to pay for uninsured people, and just how much it costs the taxpayers for each bill that introduced, and what it costs to have a Constitutional Amendment on the ballot. You know, since Florida has so much surplus money floating around.

Leave it to Bill Moyers to be the voice of sanity in an otherwise insane discussion about healthcare reform.

A recent report showing the majority of bankruptcies in America are healthcare related (and most of those people have healthcare insurance) should be causing Americans to demand that our Congress Critters take a serious look at single payer as the only real way to reform healthcare. But it’s just not happening, and Obama and the Congress have been bought and paid for by the insurance and healthcare industries.

The water-carriers for the health insurance industry (see list above) have managed to mischaracterize the plan as “socialized medicine,” and convince us that we do not want “government bureaucrats” running our healthcare (never mind that these members of Congress have their very own government run, “socialized,” health insurance, and they are doing very well…and not willing to share).

I have written about this before, and just don’t understand why we think we’re better off having an insurance company bureaucrat make our healthcare decisions.It’s important to remember that, as publicly traded companies, insurance companies do NOT have any obligation to keep you healthy or get you well when you get sick. Their one and only LEGAL obligation is to increase shareholder value, and they don’t accomplish that goal by paying your healthcare bills. They do it by finding ways to NOT pay your healthcare bills. So wise-up America. If we want to have a well functioning single-payer option we can. It’s just something we have to demand of our leaders.

But back to Bill Moyers:

Health care reform is coming. Both Congress and President Obama have made it a top priority, and many expect a bill by the fall. Now comes the tricky part — designing and funding a plan. President Obama has outlined broad goals, several competing plans have been introduced in the Congress, and the Republican party recently introduced its own plan.

But Dr. David Himmelstein and Dr. Sidney Wolfe tell Bill Moyers on the JOURNAL that President Obama isn’t considering a popular plan — single-payer. In a recent town-hall meeting in New Mexico, President Obama said switching to single-payer would be too disruptive.

The term “single-payer” generally means a system in which rather than having private, for-profit insurance companies, the government runs one large non-profit insurance organization. That organization pays all the doctor, drug and hospital bills — it is the “single-payer” of all medical bills. In most single-payer plans, every American would be enrolled and would pay into the fund through taxes…

I know this video is 30 minutes long, but it’s a small investment to make for your future physical and financial well-being.

About Deep Something

This is my place to rant, rave and pontificate about anything that's on my mind. The topics frequently venture towards those never spoken about in polite company such as politics and religion. But, if you're provoked, comments are welcome.

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There is no end to education. It is not that you read a book, pass an examination, and finish with education. The whole of life, from the moment you are born to the moment you die, is a process of learning.